Clinical meaning
Coronary artery ectasia (CAE) is defined as diffuse or focal dilation of a coronary artery segment exceeding 1.5 times the diameter of the adjacent normal segment. It is found in 1-5% of patients undergoing coronary angiography. The most common association is atherosclerosis (~50% of cases), where enzymatic degradation of the media and adventitia by matrix metalloproteinases leads to vessel dilation rather than stenosis. Other causes include Kawasaki disease (leading cause in younger patients), connective tissue disorders (Marfan, Ehlers-Danlos), vasculitis (polyarteritis nodosa, Takayasu), and iatrogenic (post-PCI). The dilated segments promote blood stasis and turbulent flow, increasing thrombotic risk. Markis classification grades severity: Type I (diffuse ectasia of 2-3 vessels), Type II (diffuse ectasia of one vessel + localized of another), Type III (diffuse ectasia of one vessel), Type IV (localized/segmental ectasia).
Diagnosis & workup
Diagnostics & workup: - Coronary angiography: gold standard — dilation > 1.5x adjacent normal segment; classify by Markis types I-IV - CT coronary angiography: non-invasive alternative for follow-up and surveillance - Intravascular ultrasound (IVUS): characterizes wall structure, thrombus, and differentiates true aneurysm from pseudoaneurysm - Echocardiography: may detect proximal coronary ectasia; assess LV function - Inflammatory markers: ESR, CRP, ANA, ANCA if vasculitis suspected - Workup for Kawasaki: childhood history, echocardiographic coronary assessment - Stress testing: exercise or pharmacological stress to assess ischemic burden - CBC, coagulation studies: baseline before anticoagulation